Louse borne relapsing fever (LBRF): mortality and frequency of Jarisch-Herxheimer reaction.

Abstract

The charts of 132 louse-borne relapsing fever (LBRF) patients admitted to a teaching and provincial hospital in Northwestern Ethiopia covering the period 1970-1985 were analysed. Of the 83 males (62.9%) and 49 (37.1%) females, there were 97 patients treated with varying doses of intramuscular procaine penicillin (100,000-600,000 u) as well as a group of 35 patients treated with single or multiple doses of tetracycline. The average age of tetracycline-treated and penicillin-treated groups was similar, but 65.7% of the former group were above 20 years of age while 51.6% of the latter group were above 20 years of age. The overall rate of the Jarisch-Herxheimer (J-HR) reaction was 21.2%. The corresponding rates in penicillin- and tetracycline-treated groups were 24.7% and 11.4% respectively. Although the frequency of the J-HR reaction is twice as large in the penicillin-treated group as compared with the tetracycline- treated group, the difference is not statistically significant (P>0.05). Similarly the overall death rate following antibiotic treatment was 3.8%. In terms of the J-HR reaction, there were more deaths in the penicillin-treated group (4.1 %), with 2.8% in the tetracycline group. In terms of the frequency as well as mortality from the J-HR reaction, it appeared that penicillin had no therapeutic advantage over tetracycline, and the latter was associated with less frequent J-HR reaction and death. These findings are in contrast to the preference for penicillin in the treatment of hospitalized LBRF patients in Ethiopia at present. As there is no concensus on the treatment of LBRF, a multicentre trial involving older and more recent antibiotics is recommended.